In the past few decades great technological strides have been made in the treatment and management of diabetes. With the advent of accurate home blood glucose monitors, diabetics are now able to perforin self-monitoring of blood glucose (SMBG) and perform multiple daily injections (MDI) of insulin therapies. The test most commonly involves pricking a finger or other body part with a lancet device to obtain a small blood sample, applying the sample to test strip, and determining glucose concentration via a glucose meter. If properly trained, diabetics can use the results to correct any deviations out of a desired target range by changing their carbohydrate intake, exercising, and/or adjusting the amount of insulin injected.
While multiple daily injection therapy is commonly recommended as an initial treatment option, continuous subcutaneous insulin infusion (CSII) therapy can be recommended for those “failing” multiple daily injection therapy. Failure is most often defined as an inability to reach glycemic goals without frequent hypoglycemia and/or increased glycemic variability. Health care insurance providers typically require a health care provider to find a failure in the multiple daily injection therapy before allowing reimbursement for the continuous subcutaneous insulin infusion therapy. There is, however, little guidance on how to quantify the success or failure of multiple daily injection therapy.
Traditionally, the management of diabetes has been based on Hemoglobin Al c (HbAlc), which includes a simple cut-off for good and bad. However, in addition to a serious increase in the risk of hypoglycemia observed in patients utilizing intensive therapies, recent studies have shown that HbAlc may not be enough. Evidence has shown an HbAlc independent relationship between glycemic variability and complications. Today, yet another new technology, the continuous glucose monitor (CGM), is changing the way we think about diabetes. Continuous glucose monitors provide exponentially more information, such as for example 288 glucose values in a 24-hour period, and a more complete picture of glycemic control. The data generated by continuous glucose monitors have the potential to dramatically improve glycemic control, but at the same time, the massive amounts of information can be overwhelming to patients and health care professionals.